BOOK
Clinical Toxicology, An Issue of Emergency Medicine Clinics of North America, E-Book
(2014)
Additional Information
Book Details
Abstract
This issue of Emergency Medicine Clinics focuses on Clinical Toxicology and is edited by Drs. Daniel Lugassy and Silas Smith and includes such topics as Emerging Drugs of Abuse, Pediatric Toxicology; Dosing and Medical Errors and Child Abuse,The Approach to Toxin-Induced Coagulopathy,The Approach to Toxin-Induced Cardiovascular Failure, The Approach to Toxin-Induced Metabolic Acidosis, The Approach to Withdrawal Syndromes, The Approach to Radiation Exposure, and more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Clinical Toxicology | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Emergency Medicine Clinics Of North America\r | xi | ||
| Foreword\r | xv | ||
| Preface | xvii | ||
| Emerging Drugs of Abuse | 1 | ||
| Key points | 1 | ||
| Introduction | 1 | ||
| Prescription drug abuse epidemic | 2 | ||
| Synthetic cannabinoids | 3 | ||
| Introduction | 3 | ||
| History and Epidemiology | 3 | ||
| Pharmacology | 5 | ||
| Clinical Effects | 5 | ||
| Testing and Imaging | 7 | ||
| Treatment | 7 | ||
| Summary | 7 | ||
| Synthetic cathinones (bath salts) | 7 | ||
| Introduction | 7 | ||
| History and Epidemiology | 8 | ||
| Pharmacology | 9 | ||
| Clinical Effects | 10 | ||
| Testing and Imaging | 11 | ||
| Treatment | 11 | ||
| Summary | 11 | ||
| Other phenethylamines (2C drugs) | 12 | ||
| Introduction | 12 | ||
| Pharmacology | 12 | ||
| Clinical Effects | 13 | ||
| Testing and Imaging | 13 | ||
| Treatment | 13 | ||
| Summary | 13 | ||
| Piperazines | 14 | ||
| Kratom | 15 | ||
| Salvia | 15 | ||
| Mushrooms | 16 | ||
| Hawaiian baby woodrose (Argyreia nervosa) | 17 | ||
| Management principles | 17 | ||
| Summary | 19 | ||
| References | 19 | ||
| Pediatric Toxicology | 29 | ||
| Key points | 29 | ||
| Introduction | 30 | ||
| Cause, epidemiology, and prevention | 30 | ||
| Pediatric pathophysiologic considerations | 33 | ||
| Emergency management overview | 34 | ||
| Life Support | 34 | ||
| Evaluation, decontamination, and supportive care | 38 | ||
| History | 38 | ||
| Physical examination | 38 | ||
| Laboratory and ECG evaluation | 38 | ||
| Assessment | 40 | ||
| Specific detoxification issues | 40 | ||
| Antidotal therapy | 41 | ||
| Enhanced elimination | 43 | ||
| Supportive care | 44 | ||
| The well-appearing child with poison exposure | 44 | ||
| Deadly in small doses: persistent perils and emerging exposures | 45 | ||
| Summary | 47 | ||
| References | 47 | ||
| Toxin-induced Coagulopathy | 53 | ||
| Key points | 53 | ||
| Introduction | 53 | ||
| Background | 54 | ||
| The Coagulation Cascade | 53 | ||
| Measures of Anticoagulation | 54 | ||
| Targeted Therapies | 55 | ||
| Targeted anticoagulation | 56 | ||
| Platelet Inhibitors | 56 | ||
| Clopidogrel | 56 | ||
| Prasugrel | 57 | ||
| Ticagrelor | 57 | ||
| Heparin | 58 | ||
| Vitamin K Antagonists | 59 | ||
| Direct Thrombin (Factor II) Inhibitors | 59 | ||
| Dabigatran | 60 | ||
| Anti-Xa Inhibitors | 61 | ||
| Rivaroxaban | 61 | ||
| Apixaban | 61 | ||
| Reversal strategies | 62 | ||
| Protamine Sulfate | 63 | ||
| Phytonadione | 64 | ||
| Platelets | 65 | ||
| FFP | 65 | ||
| Prothrombin Complex Concentrate | 66 | ||
| Factor VIIa | 67 | ||
| HD | 68 | ||
| Summary | 68 | ||
| References | 69 | ||
| Toxin-Induced Cardiovascular Failure | 79 | ||
| Key points | 79 | ||
| Introduction: nature of the problem | 79 | ||
| Adverse cardiovascular events | 80 | ||
| Toxicologic tachycardia | 81 | ||
| Toxicologic bradycardia | 82 | ||
| Toxicologic vasoconstriction | 85 | ||
| Digoxin and cardioactive steroid toxicity | 87 | ||
| General management approach | 89 | ||
| Diagnostic Testing | 89 | ||
| Gastrointestinal Decontamination | 90 | ||
| Management of Toxicologic Vasoconstriction | 91 | ||
| Management of Toxicologic Bradycardia | 91 | ||
| Atropine | 91 | ||
| Calcium | 92 | ||
| Cardioactive steroid poisoning and digoxin-specific antibody fragments | 92 | ||
| Glucagon | 94 | ||
| High-dose insulin euglycemia therapy | 94 | ||
| Intravenous lipid emulsion | 95 | ||
| Adjunctive Hemodynamic Support | 96 | ||
| Disposition | 97 | ||
| Summary | 97 | ||
| References | 98 | ||
| Toxin-Induced Hepatic Injury | 103 | ||
| Key points | 103 | ||
| Epidemiology | 103 | ||
| Nature and Scope of the Problem | 103 | ||
| Incidence | 104 | ||
| Morbidity | 104 | ||
| Mortality | 105 | ||
| Physiology | 105 | ||
| Liver Structure | 105 | ||
| Liver Function | 106 | ||
| Pathophysiology | 106 | ||
| Forms of Hepatotoxicity | 106 | ||
| Acute necrosis | 106 | ||
| Cholestasis | 106 | ||
| Steatosis | 108 | ||
| Chronic hepatitis | 108 | ||
| Hepatic venoocclusive disease | 108 | ||
| Cirrhosis | 108 | ||
| Acute liver failure | 110 | ||
| Clinical presentation | 111 | ||
| Approach to toxin-induced hepatic injury | 111 | ||
| Management | 111 | ||
| Additional Laboratory Analysis | 112 | ||
| Imaging | 113 | ||
| Pathology | 113 | ||
| Specialized Care Transfer | 113 | ||
| Advanced Modalities | 114 | ||
| Specific toxins of interest | 114 | ||
| Acetaminophen | 114 | ||
| Management | 115 | ||
| Valproic Acid | 116 | ||
| Management | 117 | ||
| Mushrooms: Amanita Species | 118 | ||
| Management | 119 | ||
| Alcohol (Ethanol) | 119 | ||
| Management | 120 | ||
| Statins | 120 | ||
| Toxin-induced Respiratory Distress | 127 | ||
| Key points | 127 | ||
| Introduction | 127 | ||
| Pulmonary anatomy and physiology and response to injury | 128 | ||
| Ventilatory Capacity | 128 | ||
| Gas Exchange | 128 | ||
| Ventilatory Mechanics | 128 | ||
| Cellular Airway Components | 129 | ||
| Mucosal surfaces | 129 | ||
| Alveolar epithelium | 130 | ||
| Interstitial airway components | 130 | ||
| Agents causing pulmonary injury | 131 | ||
| Simple Asphyxiants | 131 | ||
| Carbon dioxide | 132 | ||
| Respiratory Irritants | 132 | ||
| Water-soluble irritants | 132 | ||
| RADS as a consequence of irritant exposure | 134 | ||
| Water-insoluble irritants | 134 | ||
| Oxides of nitrogen | 134 | ||
| Phosgene | 135 | ||
| Warning Properties of Irritant Gases | 135 | ||
| Direct airway injury | 135 | ||
| Ingested Caustic Agents | 135 | ||
| Thermal Airway Injury | 136 | ||
| Hydrocarbon Aspiration | 136 | ||
| Unique pulmonary toxins and toxicants | 136 | ||
| Paraquat | 136 | ||
| Asbestos | 137 | ||
| Silica | 137 | ||
| Beryllium | 138 | ||
| Usual Combinations | 138 | ||
| Fire smoke | 139 | ||
| Smog | 139 | ||
| Metal fume fever | 139 | ||
| Pulmonary Carcinogens | 139 | ||
| Toxins inhibiting oxygen transport | 140 | ||
| MetHb Inducers | 140 | ||
| Pulse oximetry in MetHb | 141 | ||
| CO | 141 | ||
| Pulse oximetry in COHb | 141 | ||
| Inhibition of oxygen use by tissues (mitochondrial poisons) | 142 | ||
| Systemic delivery of toxins by respiratory route | 142 | ||
| Summary: assessment of patients presenting with respiratory system complaints or signs | 142 | ||
| References | 143 | ||
| Toxicologic Acid-Base Disorders | 149 | ||
| Key points | 149 | ||
| Introduction | 149 | ||
| Basic acid-base physiology | 149 | ||
| Interpretation of the arterial blood gas | 150 | ||
| Identifying the Primary Acid Base Disorder | 150 | ||
| Determining Whether a Respiratory Disorder is Chronic or Acute | 150 | ||
| Determining Whether Compensation is Appropriate | 150 | ||
| Determining Whether a Metabolic Acidosis is Associated with an Anion Gap | 151 | ||
| Distinguishing a Mixed Acid-Base Disorder from an Isolated Anion Gap Acidosis | 151 | ||
| The Stewart Strong Ion Difference | 151 | ||
| Respiratory alkalosis | 152 | ||
| Salicylates | 152 | ||
| Hyperventilation due to Impaired Oxygenation | 152 | ||
| Respiratory acidosis | 152 | ||
| Opioids | 153 | ||
| Sedatives/Hypnotics | 153 | ||
| Metabolic alkalosis | 154 | ||
| Vomiting | 154 | ||
| Increased Bicarbonate Intake | 154 | ||
| Licorice Abuse | 155 | ||
| Contraction Alkalosis/Chloride Depletion Alkalosis | 155 | ||
| Metabolic acidosis | 155 | ||
| Non–Anion Gap Metabolic Acidosis | 155 | ||
| Toxins that Cause RTA | 156 | ||
| Toxins that Cause Diarrhea | 156 | ||
| Ingestion of an Absorbable Acid | 157 | ||
| Carbonic Anhydrase Inhibition | 157 | ||
| Non–anion Gap Metabolic Acidosis from Toluene and Ethylene Glycol | 157 | ||
| Dilutional Acidosis | 157 | ||
| Anion Gap Metabolic Acidosis | 158 | ||
| Basic approach to anion gap acidosis | 158 | ||
| Lactate | 159 | ||
| Ketones | 161 | ||
| Salicylates | 162 | ||
| Toxic alcohols | 162 | ||
| Summary | 163 | ||
| Acknowledgments | 164 | ||
| References | 164 | ||
| An Approach to Chemotherapy-Associated Toxicity | 167 | ||
| Key points | 167 | ||
| Introduction | 167 | ||
| Chemotherapeutic agent classification | 168 | ||
| Chemotherapeutic emergencies | 171 | ||
| Neurologic Emergencies | 171 | ||
| Clinical evaluation | 172 | ||
| Diagnostic evaluation | 172 | ||
| Management | 172 | ||
| Antidote considerations: Methylene blue | 174 | ||
| Intrathecal (IT) Emergencies | 174 | ||
| Wrong agent or wrong route | 174 | ||
| Intrathecal dosage errors and pumps | 175 | ||
| Most common intrathecal scenarios | 175 | ||
| Management of intrathecal emergencies | 176 | ||
| Cardiovascular Emergencies | 176 | ||
| Clinical evaluation | 177 | ||
| Diagnostic evaluation | 177 | ||
| Management | 177 | ||
| Antidotal considerations: Dexrazoxane | 177 | ||
| Hematopoietic Emergencies | 179 | ||
| Clinical manifestations | 180 | ||
| Central Nervous System Toxicity | 205 | ||
| Key points | 205 | ||
| Introduction | 205 | ||
| Patient history | 206 | ||
| Clinical presentation | 207 | ||
| CNS Depression | 208 | ||
| Gamma-aminobutyric acid agonists | 208 | ||
| Opioid receptor agonists | 209 | ||
| Central alpha2-adrenergic agonists | 209 | ||
| Antipsychotics | 209 | ||
| Anticonvulsants | 210 | ||
| Nonopioid analgesics | 211 | ||
| Nonpharmaceutical agents | 211 | ||
| Agitated Delirium | 211 | ||
| Muscarinic receptor antagonists | 211 | ||
| Serotonergic agents | 212 | ||
| Sympathomimetic agents | 213 | ||
| Seizures | 214 | ||
| Bupropion | 214 | ||
| Isoniazid | 214 | ||
| Methylxanthines | 214 | ||
| Tramadol | 215 | ||
| Diagnostic testing | 215 | ||
| Laboratory Analysis | 215 | ||
| Blood | 215 | ||
| Urine | 215 | ||
| ECG | 216 | ||
| Radiology | 216 | ||
| EEG | 216 | ||
| Differential diagnosis | 216 | ||
| Management | 217 | ||
| CNS Depression | 217 | ||
| Agitated Delirium | 218 | ||
| Seizures | 218 | ||
| Summary | 218 | ||
| References | 219 | ||
| Marine Envenomations | 223 | ||
| Key points | 223 | ||
| Introduction | 223 | ||
| Vertebrates | 224 | ||
| Stingrays (Class Chondrichthyes) | 224 | ||
| Epidemiology | 224 | ||
| Venom | 224 | ||
| Presentation | 224 | ||
| Treatment | 226 | ||
| Family Scorpaenidae and Trachinidae | 227 | ||
| Stonefish (genus Synanceia) | 228 | ||
| Epidemiology | 228 | ||
| Venom | 228 | ||
| Ionizing Radiation Injuries and Illnesses | 245 | ||
| Key points | 245 | ||
| Introduction | 245 | ||
| Applicable physics | 246 | ||
| Types of Ionizing Radiation | 246 | ||
| Alpha (α) | 246 | ||
| Beta (β) | 246 | ||
| Positron (β+) | 247 | ||
| Neutron | 247 | ||
| Gamma rays and X rays | 247 | ||
| Units of Measurement | 248 | ||
| Radiation Dose | 248 | ||
| Equivalent Dose | 248 | ||
| Radiobiology | 248 | ||
| Deterministic Effects of Ionizing Radiation | 249 | ||
| Stochastic Effects of Ionizing Radiation | 249 | ||
| Exposure or Irradiation Versus Contamination | 249 | ||
| Radiation Protection and ALARA | 250 | ||
| Radiosensitivity and Radioresistance | 250 | ||
| Median Lethal Dose 50/60 (LD50/60) | 251 | ||
| Chromatid Breakage and Mitotic Death | 251 | ||
| Apoptosis | 251 | ||
| Direct Ionization and Indirect Cellular Interactions | 252 | ||
| Initial management of radiation casualties | 252 | ||
| Overall medical management of radiological exposures | 252 | ||
| Acute Radiation Syndrome | 252 | ||
| Hematopoietic Syndrome | 253 | ||
| Absolute neutrophil count | 255 | ||
| Enucleated cells | 255 | ||
| Medical management of the H-ARS | 256 | ||
| Bridging cytopenic gaps | 256 | ||
| Cytokines or colony-stimulating factors | 256 | ||
| Bone marrow or stem cell transplants | 256 | ||
| Prophylactic antimicrobials | 256 | ||
| Treatment of other infections | 257 | ||
| Cutaneous Radiation Syndrome or Local Radiation Injury | 257 | ||
| Medical management of CRS | 257 | ||
| Gastrointestinal Subsyndrome | 258 | ||
| Management of G-ARS | 258 | ||
| Neurovascular Syndrome | 258 | ||
| Internal Contamination with Radioactive Materials | 259 | ||
| Management of internal contamination with radioactive materials | 259 | ||
| Specific treatment methods | 259 | ||
| Potassium iodide | 260 | ||
| Radiological and nuclear incidents of medical and public health concern | 260 | ||
| Radiological Exposure Device | 261 | ||
| Radiological Dispersal Device | 261 | ||
| Nuclear Power Plant Incident | 261 | ||
| Improvised Nuclear Device/Nuclear Weapon | 262 | ||
| Summary | 262 | ||
| References | 262 | ||
| Index | 267 |